<!DOCTYPE html>
<html>
<head lang="en">
    <meta charset="UTF-8">
    <title></title>
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css">
    <link rel="stylesheet" href="index.css">
    <script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.1/jquery.min.js"></script>
    <script src="http://maxcdn.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script>
    <link rel="stylesheet" href="http://maxcdn.bootstrapcdn.com/font-awesome/4.3.0/css/font-awesome.min.css">
</head>
<body>

<div class="container container-top" >
    <div class="row">
        <div class="col-md-12">
            <div class="well well-sm">
                <form class="form-horizontal" method="post">
                    <fieldset>
                         <legend class="text-center header">Contact us</legend>
                        <div class="form-group">
                            <span class="col-md-1 col-md-offset-2 text-center"><i class="fa fa-user bigicon fa-3x"></i></span>
                            <div class="col-md-8" style="margin-top: 5px">
                                <input id="fname" name="name" type="text" placeholder="First Name" class="form-control">
                            </div>
                        </div>
                        <div class="form-group">
                            <span class="col-md-1 col-md-offset-2 text-center"><i class="fa fa-user bigicon fa-3x"></i></span>
                            <div class="col-md-8"  style="margin-top: 5px">
                                <input id="lname" name="name" type="text" placeholder="Last Name" class="form-control" >
                            </div>
                        </div>
                        <div class="form-group">
                            <span class="col-md-1 col-md-offset-2 text-center"><i class="fa fa-envelope-o bigicon fa-3x"></i></span>
                            <div class="col-md-8" style="margin-top: 5px" >
                                <input id="email" name="name" type="text" placeholder="Email Address" class="form-control">
                            </div>
                        </div>
                        <div class="form-group">
                            <span class="col-md-1 col-md-offset-2 text-center"><i class="fa fa-phone-square bigicon fa-3x"></i></span>
                            <div class="col-md-8" style="margin-top: 5px">
                                <input id="phone" name="name" type="text" placeholder="Phone" class="form-control">
                            </div>
                        </div>
                        <div class="form-group">
                            <span class="col-md-1 col-md-offset-2 text-center"><i class="fa fa-pencil-square-o bigicon fa-3x"></i></span>
                            <div class="col-md-8" style="margin-top: 5px">
                                <textarea class="form-control " id="massage" placeholder="Enter youre massage for us here." rows="7" ></textarea>
                            </div>
                        </div>
                        <div class="form-group">
                            <div class="col-md-12 text-center">
                                <button type="submit" class="btn btn-primary btn-lg">Submit</button>
                                <button type="reset" class="btn btn-primary btn-lg">Reset</button>
                            </div>

                        </div>

                    </fieldset>
                </form>
            </div>
        </div>
    </div>


</div>


</body>
</html>